Statement of the Problem
The skin is the largest organ of the mammalian body and normally serves several critical functions. One of the primary functions of intact human skin is the control of loss of water from the body and the prevention of bacterial infection. The intact skin of humans and mammalian animals serves as a highly efficient barrier to the evaporation of body water and the loss of body heat. The most external layer of the epidermis is cornified. It is a very effective moisture barrier and prevents evaporation of the body water.
Large burns destroy the water proof barrier, thus permitting dehydration of the body. A second immediate problem, caused within 12-24 hours after burns, is vascular injury. It has been shown that after thermal injury, capillary permeability is markedly increased. The capillaries become freely permeable with extravasation of fluid and proteins into the interstitial tissue.
Infection is another critical problem to deal with in the burned patient. Full-thickness skin burns largely diminish the protective mechanism of the skin against infection, and leaves necrotic tissue. The large amount of necrotic tissue represented by the burn scar serves as an ideal culture medium for bacteria growth.
Restitution, or avoidance of loss, of the foregoing three primary functions of the intact human skin, is the problem to be resolved in treating skin burns.